Ultrasonic osteotomy in oral surgery and implantology Alberto González-García, DDS, a Márcio Diniz-Freitas, DDS, PhD, a Manuel Somoza-Martín, DDS, PhD, a and Abel García-García, MD, PhD, b Santiago de Compostela, Spain UNIVERSITY OF SANTIAGO DE COMPOSTELA Over the past decade, coinciding with the appearance of a number of new ultrasonic surgical devices, there has been a marked increase in interest in the use of ultrasound in oral surgery and implantology. This paper reviews the published literature on ultrasonic osteotomy in this context, summarizes its advantages and disadvantages, and suggests when it may and may not be the technique of choice. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:360-367) The use of ultrasound for medical diagnosis was first investigated in the 1940s and 1950s and became well established in the 1960s. The possibility of surgical applications was also explored in the 1940s, 1 but wide clinical use in Western nations was for a long period limited to dental practice, where it continues to be used for supra- and infragingival dental cleaning, and root scaling, 2-4 for apical box preparation prior to regro- grade filling, 5 for root canal preparation, 3 and for the removal of posts, cores, and occasionally broken instru- ments. 4,6 The 1980s and 1990s saw the growing clinical introduction of both focused ultrasound 7-9 and the ul- trasonic scalpel. 10-12 Ultrasonic osteotomy preparation was studied following earlier works, 13,14 but it is only in the last few years that ultrasonic devices for osteot- omy have become competitive with conventional in- struments in certain contexts. 15-19 To our knowledge, ultrasonic osteotomes are currently manufactured by Mec- tron (Genova, Italy), BTI (Vitoria, Spain), Resista (Ome- gna, Italy), Satelec (Merignac, France), Electro Medical Systems (Nyon, Switzerland), and NSK (Kanuma, Japan); other companies are on the verge of entering the market. This paper reviews the published literature on ultra- sonic osteotomy in oral surgery and implantology, sum- marizes its advantages and disadvantages, and suggests when it may be the technique of choice and when not. This review is based on a search of the main on-line medical databases for papers on ultrasonic bone surgery published in major oral surgery, periodontal and dental implant journals between January 1960 and August 2008, using the keywords “piezoelectric,” “ultrasonic,” “bone,” and “surgery.” Other relevant papers were identified in the references sections of papers retrieved by the primary search. It should be pointed out that 1 of the authors of a number of the papers reviewed appear to have a commercial interest in the osteotomes used in their studies. BASIC CONCEPTS Ultrasound consists of mechanical waves of frequen- cies greater than about 20 kHz, the upper limit of human hearing. Although vibrations of these frequen- cies can be produced by various means, most medical devices currently use the piezoelectric effect, discov- ered in 1880 by Jacques and Pierre Curie. 20 This is the phenomenon whereby an electric potential develops across certain crystalline materials when they are com- pressed; and these materials become deformed in an electric field. If the polarity of the applied field alter- nates, the crystal transduces this alternation into an oscillation of its surface, and this movement is trans- mitted to adjacent matter. Ultrasonic medical devices generally use barium ti- tanate transducers. In ultrasonic scalpels and os- teotomes they are located in the handpiece, which is connected by a cable to the control unit. Their move- ment is transmitted to a working piece that is inserted in the handpiece and has a titanium or steel tip, with or without a diamond or titanium nitride coating, that is shaped appropriately for the intended task (Fig. 1). To cut bone while minimizing the risk of damage to soft tissues, osteotomes use ultrasound of relatively low a Assistant Professor, Departments of Oral Surgery and Oral Medi- cine. b Head of Section, Department of Maxillofacial Surgery, Clinical University Hospital. Received for publication Oct 3, 2008; returned for revision Apr 1, 2009; accepted for publication Apr 13, 2009. 1079-2104/$ - see front matter © 2009 Published by Mosby, Inc. doi:10.1016/j.tripleo.2009.04.018 360 Vol. 108 No. 3 September 2009 ORAL AND MAXILLOFACIAL IMPLANTS